What is Chemical Addiction?
In the previous blog, I defined the meaning of Substance Use Disorders. However, the term “addiction” as it relates to substance use often connotes a subtle, but important difference. Whereas a Substance Use Disorder (SUD) is usually characterized by loss of control over a substance, addiction suggests more of a preoccupation to use. That preoccupation to use can be associated with a psychological obsession to use or a physical compulsion to use. Many times it can be both.
Let’s first take a look at psychological addiction. Psychological addiction represents more of the obsessive qualities of substance use. In other words, the incessant thoughts of using substances; the frequent and almost uncontrollable urges to use, distracting one from other activities of daily life. These preoccupations to use can be very powerful causing one to become irritable and psychologically unavailable to others until the obsession to use has been satiated with actual use. Most individuals dependent on substances experience some degree of psychological addiction. One of the best depictions of this psychological preoccupation was portrayed in the writing of J.R. Tolkien’s Lord of the Rings trilogy. The power of the magic ring led to such mental preoccupation that the character Gollum would stare at it calling it “my precious.” His life became completely obsessed with the ring. Nothing mattered more than getting his hands on the ring.
Physical addiction is less common than psychological addiction. That’s because not every substance is believed to lead to physical addiction. This point is a matter of controversy. The substances that are currently associated with physical addiction fall into two categories: depressants and opioids. Depressants include alcohol, benzodiazepines (i.e., Valium, Xanax, Klonopin, and Ativan) and barbiturates (i.e., phenobarbital, Luminal). Opioids include opium as a pure opiate, partially synthetic opioids such as heroin, codeine, and morphine and completely synthetic opioids like hydrocodone, oxycodone, and methadone.
Physical addiction is defined by two factors: withdrawal and tolerance. Withdrawal is defined as the body’s physiological response to the absence of ingesting the substance. Withdrawal is usually associated with daily use of one of the substances mentioned above leading to characteristic, physiological symptoms for several days to several weeks when abstaining from the substance. These symptoms can include sweating, nausea, shakes, agitation, even delusions and hallucinations. In very heavy physical addiction to depressants like alcohol or benzodiazepines, there are even fatalities associated with withdrawal when going “cold turkey”. Alternative medications are used to treat cases of physical withdrawal. Tolerance is defined as needing more of the substance over time to achieve the same level of intoxication or desired effect. For example, a person may initially find that six drinks would provide the adequate dosage of intoxication needed, but after months of daily use need two to three times that amount to obtain the same effect. This same effect applies to many pills and opioid substances. Many believe that even daily marijuana use can lead to withdrawal symptoms and tolerance.
In summary, chemical addiction can be exhibited through psychological addiction and/or physical addiction. While every mood-altering substance can lead to psychological addiction, it is current belief that not every mood-altering substance leads to physical addiction. Share your thoughts on this topic. I would love to hear.
Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.